Practice Patterns for Outpatients With Stable Coronary Artery Disease: A Case Vignette-based Survey Among French
Christophe Bauters1, Gilles Lemesle1, Nicolas Lamblin1
1Centre Hospitalier Régional et Universitaire de Lille, Lille, France; Inserm U1167, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France; Faculté de Médecine de Lille, Lille, France.
Insights
Clinical practice for stable coronary artery disease (CAD) varies significantly when guidelines are unclear. This study surveyed cardiologists, revealing diverse approaches to managing asymptomatic CAD and recurrent angina, highlighting the need for further research.
Area of Science:
- Cardiology
- Clinical Practice Guidelines
- Coronary Artery Disease Management
Background:
- Medical management of coronary artery disease (CAD) often relies on guidelines, but many routine clinical scenarios lack specific recommendations or have low evidence.
- Understanding current practice patterns in stable CAD is crucial for identifying areas needing further evidence-based guidance.
Purpose of the Study:
- To assess the current practice patterns of cardiologists in the routine management of patients with stable coronary artery disease (CAD).
- To identify associations between physician characteristics and specific management strategies in stable CAD.
Main Methods:
- A survey with six questions on two clinical scenarios concerning stable CAD management was distributed to 345 cardiologists in the Nord-Pas-de-Calais Region, France.
- Practice patterns were evaluated globally, and associations with physician demographics (age, gender, sub-specialty) and practice type were analyzed.
Main Results:
- High response rate (92%) provided robust data on stable CAD management.
- Significant variability observed in managing asymptomatic CAD (e.g., exercise testing, beta-blocker withdrawal) and recurrent angina (e.g., diagnostic testing approach).
- Physician characteristics, including age, gender, academic environment, and interventional cardiology practice, were associated with specific management choices.
Conclusions:
- Practice patterns for routine clinical situations in stable coronary artery disease (CAD) demonstrate considerable variation in the absence of high-level evidence.
- These findings underscore the need for future clinical trials to address specific clinical questions in stable CAD management.
Background:
Although medical management of patients with coronary artery disease (CAD) is often based on scientific guidelines, a number of everyday clinical situations are not specifically covered by recommendations or the level of evidence is low. The aim of this study was to assess practice patterns regarding routine management of patients with stable CAD.
Methods:
A survey comprising six questions on two clinical scenarios regarding stable CAD management was sent to 345 cardiologists from the Nord-Pas-de-Calais Region (France). We first assessed practice patterns globally and then searched for associations with physician characteristics (age, gender, sub-specialty, and type of practice).
Findings:
The response rate was 92%. Regarding management of asymptomatic CAD, 86% of the cardiologists performed routine exercise testing, before which, 69% withdrew β-blockers. After a positive exercise test, 26% immediately performed coronary angiography and 67%, further imaging tests. In the absence of left ventricular dysfunction or history of myocardial infarction, routine β-blocker prescription for stable CAD was selected by 43%. When anticoagulation was needed for atrial fibrillation, 41% initiated direct oral anticoagulants rather than vitamin-K antagonists and 50% combined aspirin with anticoagulants. For recurrent stable angina in patients with known CAD, 24% performed coronary angiography directly, 49% requested a stress test, and 27% opted for medical therapy without further diagnostic testing. Age, gender of the cardiologist, academic environment, and practice of interventional cardiology were associated with certain management patterns.
Interpretation:
When not guided by high-level recommendations, practice patterns for routine clinical situations in stable CAD vary considerably. Future clinical trials should address these clinical interrogations.
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